Nishino Tomohiko, Hirano Sakurako, Takemura Shin, Tomori Shinya, Ono Sayaka, Takahashi Kazuhiro, Mimaki Masakazu
Department of Pediatrics, Teikyo University School of Medicine, Tokyo, Japan.
Pediatr Res. 2025 Mar 4. doi: 10.1038/s41390-025-03956-8.
The optimal puncture approach for real-time ultrasound-guided native kidney needle biopsy in children remains undetermined due to insufficient evidence. This study evaluated various puncture approaches for glomeruli count and arterial injury in the small kidneys of piglets.
A total of 144 kidneys sourced from a slaughterhouse were examined. On each kidney, three puncture approaches were performed on the lower pole using a 16-gauge needle: Caudocranial, Craniocaudal, and Vertical. Blinded pediatric nephrologists assessed core length, glomeruli count, and arterial injury.
The kidneys had a mean vertical length of 9.31 ± 0.59 cm. Of 432 punctures, no punctures traversed the kidney. The Vertical approach yielded a significantly shorter core length than other methods (P < 0.001), but the glomeruli count was consistent across approaches (P = 0.41). Over 60% of the biopsies resulted in arterial injury, with the Caudocranial approach showing significantly higher injury rates (P < 0.03).
This study focused on puncture techniques in a pediatric model, suggesting that the Craniocaudal and Vertical approaches are advantageous for selective glomerular sampling without increasing the arterial injury risk. Although further research on smaller kidneys is necessary, these findings offer valuable guidance for biopsy approaches to small kidneys, particularly in pediatric patients.
Kidney biopsy is essential for establishing diagnosis and determining treatment strategies; however, there is no consensus on the puncture approach in children who have the additional risk factor of small-sized kidneys. This study compared between biopsy specimens from piglet models of pediatric kidneys to clarify the best puncture approach based on pediatric characteristics. Although the same number of glomeruli were sampled using all approaches, the Caudocranial approach exhibited a significantly higher incidence of arterial injury. In kidney biopsy that considers the characteristics of children with small kidneys, the Craniocaudal or Vertical approaches may improve the safety and quality of biopsy specimens.
由于证据不足，儿童实时超声引导下经皮肾穿刺活检的最佳穿刺方法仍未确定。本研究评估了仔猪小肾脏的各种穿刺方法对肾小球计数和动脉损伤的影响。
共检查了144个来自屠宰场的肾脏。在每个肾脏的下极，使用16号穿刺针进行三种穿刺方法：尾头方向、头尾方向和垂直方向。由不知情的儿科肾病学家评估穿刺组织长度、肾小球计数和动脉损伤情况。
肾脏的平均垂直长度为9.31±0.59厘米。在432次穿刺中，没有穿刺针穿透肾脏。垂直穿刺法获得的穿刺组织长度明显短于其他方法（P<0.001），但各穿刺方法的肾小球计数一致（P=0.41）。超过60%的活检导致动脉损伤，尾头方向穿刺法的损伤率明显更高（P<0.03）。
本研究聚焦于儿科模型中的穿刺技术，提示头尾方向和垂直方向穿刺法有利于选择性肾小球取材，且不增加动脉损伤风险。尽管对更小的肾脏仍需进一步研究，但这些发现为小肾脏活检方法提供了有价值的指导，尤其是对儿科患者。
肾活检对于明确诊断和确定治疗策略至关重要；然而，对于存在小肾脏这一额外风险因素的儿童，穿刺方法尚无共识。本研究比较了儿科肾脏仔猪模型的活检标本，以根据儿科特征明确最佳穿刺方法。尽管所有方法获取的肾小球数量相同，但尾头方向穿刺法的动脉损伤发生率明显更高。在考虑小肾脏儿童特征的肾活检中，头尾方向或垂直方向穿刺法可能会提高活检标本的安全性和质量。
